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On the other side of the debate, those concerned about pinkwashing say they're not just worried about promoting potentially unhealthy products, but about the message being off in general, namely the focus on both screening and a cure.

"We need to be focused on prevention," says Stacy Malkan, author of Not Just a Pretty Face: The Ugly Side of the Beauty Industry, founder of the Campaign for Safe Cosmetics, which has taken companies like Estee Lauder, Avon, and Revlon to task for being huge backers of pink ribbon campaigns and walks for the cure while at the same time refusing to discuss phasing out toxic chemicals in their products. "Despite all these multiple billions of dollars we’re no closer to a cure than we were. A cure is very elusive. There are so many contributing factors to cancer that the idea that there could be a magic pill that addresses all the different forms and be done with it is a fantasy. It’s nice to hope for a cure, but we can take action right now with prevention."

Breast Cancer Action's Karuna Jaggar echoes these concerns.

In the beginning, the pink ribbon campaigns were part of solving a visibility problem, but today the pink ribbons are blinding us to the real issues," Jaggar says. "The issue is no longer awareness, the issue is understanding the root causes of the disease. Awareness is often channeled into screening and mammography, with no recognition of the limits of mammography. Mammography is a tool, an important tool, but it is not the solution to the epidemic. It detects cancer after it has already occurred. Even women diagnosed early may die of the disease, and too often do.

A New York Times article last month highlighted the limits of mammography as well, interviewing doctors about their concerns that pink ribbon campaigns have led women to believe that mammograms in and of themselves can prevent breast cancer. Komen's Thompson points out, however, that many women continue to skip these basic screenings. "A study released two months ago surveyed 1.5 million women and found that 50 percent of eligible women (meaning they were over 40 and insured) were not taking advantage of annual screenings," she says. "That means that there are early-stage cancers that aren’t being detected. So that’s very much an important part of where we are."

Thompson also notes that the jury is still out on the science around environmental causes of breast cancer. "For many years there have been people who believe there are links between environmental causes and cancer, but we don’t have scientific evidence to back that up," Thompson says. "There are a lot of beliefs and emotions, but we are an evidence-based organization and right now the evidence isn't there."

Nonetheless, Thompson says Komen did recently fund the largest ever study to the Institute of Medicine to review the correlation between environmental factors and breast cancer. That study is due out in two months. In the meantime, Jaggar and Malkan note that while it's difficult to say that this particular chemical causes that specific cancer, the evidence is mounting against certain ingredients (bisphenol-A, phthalates, mercury and lead to name a few) to the point where the precautionary principle should be invoked.

"In the absence of scientific consensus, while we’re conducting the research, what do we do in the meantime?" Jaggar says. "When the weight of the evidence suggests a threat of harm, we believe you act to prevent harm before it occurs. You take every precaution to preserve women’s health. Just fifty years ago, the liftetime risk (if you lived, as the average woman did, to 85) of getting breast cancer was one in twenty. In 1984 it was one in fourteen, today it’s one in eight. That means it has grown from a personal risk of 5 percent to over 12 percent. That's approaching over a 250 percent increase in just 50 years. In the face of that alarming statistic, that’s where we take issue with Komen and others. When in doubt, leave it out."

Malkan adds that more of the funds raised by pink ribbon campaigns need to be going to fund research into causes. Komen does donate millions of dollars a year to research and prevention, but it's still a percentage of the billion or so dollars raised annually. "There are many useful ways in which women have been helped by better treatment options and early detection, but we need to look at why so many women are getting breast cancer in the first place," Malkan says. "There are some important indicators that have been discovered – like the fact that breast cancer rates dropped slightly when so many women stopped using hormone replacement therapy –that’s huge, and that’s the sort of thing we should be investing research money in. Synthetic estrogens is another big one."

Good Business

In a perfect world, everyone advocating for women's health would be on the same team. As media and consumer attention around pinkwashing grows, that may just happen. "We're absolutely seeing more attention to the idea of prevention," Malkan says. "A very good example is the President’s cancer panel – they made a very strong statement that prevention is important and that we need to be doing more to regulate carcinogens, and those were mainstream scientists appointed by Bush saying we need to do something about this."

To stem what they see as a surge of pinkwashing, Breast Cancer Action encourages consumers to first consider donating directly to a charity or research foundation they want to support, and then to ask five key questions before buying a pink ribbon product: How much money goes toward breast cancer, and is the company transparent about it? What is the maximum amount that will be donated? How are funds raised? Where does the money go and what sorts of programs does it support? What is the company doing to ensure its products aren't contributing to the breast cancer epidemic?

More research is being conducted into environmental causes as well, and the results of those studies are becoming more and more public. With so many such reports surfacing, and Komen's own study of environmental links to cancer due out shortly, companies may voluntarily become more careful about the sorts of products they put pink ribbons on for fear of consumer backlash or even legal action.

"The reason companies put pink on their stuff is likely to imply some sort of association with Komen or the cure, or breast cancer research in general," says Chris Cole, a partner at Manatt, Phelps & Phillips and a leading authority on false advertising. "The idea is to create a sense around their brand, and if they're not actually doing anything, then that’s false advertising plain and simple. Moreover, if they're implying to consumers that if they buy this product the company will give some profits to a charity then they're implying an association that’s not there and I think the Federal Trade Commission would definitely get involved in a particularly egregious case."